Ch. 12: Disorders of the Liver and Biliary Tract Flashcards Preview

Pathology > Ch. 12: Disorders of the Liver and Biliary Tract > Flashcards

Flashcards in Ch. 12: Disorders of the Liver and Biliary Tract Deck (80):
1

name the two blood supplies of the liver

portal vein & hepatic artery

2

T/F: cirrhosis is reversible

False

3

portal vein goes ( ) liver

into the

4

what makes up a portal triad?

1) bile duct
2) hepatic artery
3) portal vein

5

produced in the spleen (and liver) from hemoglobin breakdown, conjugated to glucuronide in the liver

bilirubin

6

increased uncongugated bilirubin

hemolysis

7

increased conjugated bilirungin suggest

biliary obstruction

8

decreased albumin suggest

liver disease

9

increased PT and PTT (decreased coagluation factors) suggest

liver disease

10

what are the four clinical sydromes of liver disease?

1) jaundice and cholestasis
2) cirrhosis
3) portal HTN
4) hepatic failure

11

what is jaundice?

hyperbilirubinemia

12

pre-hapitic jandice:

unconjugated bili (hemolysis)

13

hepatic jaundice:

conjugated or unconjugated bili (ex. viral hepatitis, cirrhosis, drugs)

14

post-hepatic jaundice

conjugated bili (ex. obstruction by gallstones or cancer)

15

accumulation of bile in the liver by intraheptaic or extraepatic flow obstruction or defective hepatocyte bile secretion

cholestasis

16

what is cirrhosis?

IRREVERSIBLE scarring

17

cirrhosis is ( )% ETOH and viral hepatitis; ( )% cryptogenic

65%
25%

18

cirrhosis results in...

portal hypertension

19

what is the only therapy for cirrhosis?

transplant

20

what is portal hypertension?

obstruction to portal blood flow

21

prehaptic portal hypertension

portal vein thrombosis, scarring, tumor

22

hepatic portal hypertension

cirrhosis (most common!)

23

posthepatic portal hypertension

right CHF, hepatic vein thrombosis

24

signs of portal hypertension

varicies and splenomegaly

25

portosystemic shunts; rectal, esophageal, caput medusae (umbilical vein)

varices

26

CPC, may also have hypersplenism

splenomegaly

27

what is hepatic failure?

loss of 80-90% of functional capacity of liver

28

most common cause of heaptic failure

cirrhosis

29

hepatic failure leads to... (which does what?)

hepatic encephalopathy (increased ammonia and other toxins)

30

hepatic failure may develop what?

hapatorenal and hepatopulmonary syndromes (both have unknown etologies)

31

what percentage of hepatic failure is fatal?

80%

32

in ACUTE cases of hepatic failure, half are due to ( ) in the US; remaining cases are due to ( )

-acetominophen
-other drugs, autoimmune hepatitis or viral hepatitis

33

what are the 3 hepatitis clinicopathologic syndromes?

1) acute viral hepatitin
2) carrier state
3) chronic viral hepatitis

34

is there a thing as chronic hep A virus?

nope!

35

viral hepatitis: causes epidemic hepatitis

hepatitis A virus (HAV)

36

viral hepatitis: has infected 1/3 of the world population (2 bill), 350 mill have chronic infection

hep B (HBV)

37

viral hepatitis: usually (50-70%) progresses to chronic liver disease

hep C (HCV)

38

HBV: what percent is subclinical infection? how many can recover completely?

65%
90%

39

HBV: what percentage symptomatic acute hepatitis? how many can recover?

35%;
90%

40

Rx for HCV...how much is this?

interferon and/or Solvadi;
$1,000/tab for 12 or 24 weeks)

41

viral hepatitis: infects only those with HBV

HDV

42

HDV: how type usually recovers?

coinfection (at the same time as HBV)

43

HDV: which type has most go on to chronic hepatitis

superinfection (after previous HBV)

44

viral hepatitis: most common form of epidemic hepatitis in India

HEV

45

viral hepatitis: similar to HAVE (transmitted by food/water, mild, no chronic or carrier state)

HEV

46

viral infection: exceptionally dangerous to pregnant women (20% fatality)

HEV

47

non-viral inflammatory liver disease: types of abscesses

1) bacterial/fungal
2) amebic: entamoeba histolytica

48

abscess: more common in immunodeficient pts, high mortality

bacterial/fungal

49

abscesses: countries with poor sanitation practices

amebic: entamoeba histolytic

50

chronic progressive hepaitis

autoimmune hepatitis

51

autoimmune hepatitis: what percent female?

80% (>50% have other autoimmune diseases)

52

autoimmune hepatitis: most have ( ) muscle or ( ) antibodies

-anti-smooth
-anti-mitochondrial (these are more common in PBC)

53

how many of cases of fulminant liver failure are due to ACETAMINOPHEN?

half of the cases!

54

which toxic liver injury are dose-related?

alcohol, acetaminophen

55

which toxic liver injuries are NOT dose-related?

other drugs, anesthetic gase
(aka idiosyncratic)

56

what is a leading cause of liver disease?

alcohol abuse

57

metabolic liver disease: very common, metabolic syndrome (obesity, hyperlipidemia, htn and insulin resistance)

non-alcoholic fatty liver disease (NASH)

58

NAH may progress to...

cirrhosis

59

metabolic liver disease: autosomal recessive; increased iron in liver, pancreas, heart, skin, joint (M:F ratio?)

hemochromatosis (10:1)-- 1/200 people

60

metabolic liver disease: disorder of copper metabolism (rare, autosomal recessive, increased copper in liver, brain)

Wilson disease

61

metabolic liver disease:causes liver disease and emphysema

hereditary alpha-1 antitrypsin deficiency

62

prolonged biliary obstruction causes ( )

secondary biliary cirrhosis

63

what is the most common cause of biliary cirrhosis?

gallstones (then pancreatic cancer)

64

circulatory disorders: inhibits intrahepatic flow

cirrhosis

65

circulatory disorders: secondary to CHF

chronic passive congestion

66

circulatory disorders: obstruction of the main hepatic vein

Budd-Chiari syndrome

67

tumors of liver: most common tumor in liver

metastases

68

tumors of liver: oral contraceptives

hepatic adenoma

69

tumors of liver: malignant tumor, CHILDREN

hepatoblastoma

70

tumors of liver: risk increased with cirrhosis, chronic HBV and HCV

hepatocellular carcinoma

71

tumors of liver: increased serum AFP levels

hepatocellular carcinoma

72

tumors of liver: risk increased with HCV, sclerosing cholangitis

cholangiocarinoma

73

tumors of liver: cholangiocarcinoma survival rate

15% 2 year survival

74

cholelithiasis vs. choledocholihiasis

choledocholithiasis= stones in common bile duct

75

gallstones: cholesterol stones= ( )%

80%

76

gallstones: risk factors for cholesterol stones

female, obesity, older

77

gallstones: pigement stones ( )%

20%

78

gallstones: pigment stone risk factors

chronic hemolysis

79

gallstones may lead to ( )

cholecystitis (acute and chronic)

80

what is the most important problem of extrahepatic bile ducts?

Obstruction!